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Marketing Techniques Could be Used in Health Screening, Researchers Claim

Feb 13, 2018

Could family doctors use “association rule mining” to improve health outcomes? They could if they were “nudged”.

Association rule mining is used in marketing: It identifies interesting patterns in large databases containing many variables. The technique can help marketers understand and influence consumer behaviour by offering results and recommendations for products a buyer may wish to purchase based on their past actions or the actions of others with similar profiles.

“When you buy something at Amazon, they also show you ‘people like you bought this’ or ‘you just bought this, would you also be interested in a related item’,” says Dr. Michelle Greiver, a Clinician Scientist at Department of Family and Community Medicine (DFCM), UTOPIAN’s Acting Director and Scientist at North York General Hospital.

“We were wondering if we could use a similar approach to try to improve health outcomes by making it easier for family doctors to ask patients one more important question about their health.”

A study conducted by researchers and biostatisticians at DFCM examined the potential use of association rules in Electronic Medical Records using UTOPIAN data. The study looked for associations between the presence of evidence-based screens. For example, if a family doctor asks a patient about his or her tobacco use, are they also checking their patient’s cholesterol levels?

They used UTOPIAN data to examine records of individuals who were at least 45 years old as of June 30, 2015, and had at least one encounter with a practice recorded in the EMR in the two years before the date of extraction. They determined that most patients had at least one screen done but few had a complete screening that would help develop a patient’s broader risk profile.

They also found that only 80 per cent of patients had tobacco use status recorded in their EMR. Alcohol use status was even lower at 59 per cent. There are even more opportunities to record other health factors like physical activity. The study proposes the use of alerts to nudge the physician to ask one or two more questions about the patient’s health.

“It is as simple as entering one’s blood pressure and then adding a weight. All these risk factors can be entered in each patient’s record; doing this is an important aspect of quality improvement. You cannot improve what you do not measure: you cannot ask people to quit smoking if you do not ask them if they smoke!”

Having alerts that “nudge” physicians to add just a bit more information may be very effective and can be a good way to use the valuable data in Electronic Medical Records. This approach has worked for Amazon says Dr. Greiver, it may also work in family practice.

“Why do this at all? Part of the problem is that doctors get many alerts. You want to reduce the number of alerts by making them relevant and presenting them as something that family doctor might just want to do in the way that Amazon presents it to me. The number of screens done can be increased by tying them to things family doctors are already doing during the visit.”